High-sensitivity troponin T, NT-proBNP and glomerular filtration rate

A multimarker strategy for risk stratification in chronic heart failure

Alberto Aimo, James L. Januzzi, Giuseppe Vergaro, Andrea Ripoli, Roberto Latini, Serge Masson, Michela Magnoli, Inder Anand, Jay N Cohn, Luigi Tavazzi, Gianni Tognoni, Jørgen Gravning, Thor Ueland, Ståle H. Nymo, Hans Peter Brunner La Rocca, Antoni Bayes-Genis, Josep Lupón, Rudolf A. de Boer, Akiomi Yoshihisa, Yasuchika Takeishi & 10 others Michael Egstrup, Ida Gustafsson, Hanna K. Gaggin, Kai M. Eggers, Kurt Huber, Ioannis Tentzeris, W. H. Wilson Tang, Justin L. Grodin, Claudio Passino, Michele Emdin

Research output: Contribution to journalArticle

Abstract

Background: In a recent individual patient data meta-analysis, high-sensitivity troponin T (hs-TnT) emerged as robust predictor of prognosis in stable chronic heart failure (HF). In the same population, we compared the relative predictive performances of hs-TnT, N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP), hs-C-reactive protein (hs-CRP), and estimated glomerular filtration rate (eGFR) for prognosis. Methods and results: 9289 patients (66 ± 12 years, 77% men, 85% LVEF <40%, 60% ischemic HF) were evaluated over a 2.4-year median follow-up. Median eGFR was 58 mL/min/1.73 m 2 (interquartile interval 46–70; n = 9220), hs-TnT 16 ng/L (8–20; n = 9289), NT-proBNP 1067 ng/L (433–2470; n = 8845), and hs-CRP 3.3 mg/L (1.4–7.8; n = 7083). In a model including all 3 biomarkers, only hs-TnT and NT-proBNP were independent predictors of all-cause and cardiovascular mortality and cardiovascular hospitalization. hs-TnT was a stronger predictor than NT-proBNP: for example, the risk for all-cause death increased by 54% per doubling of hs-TnT vs. 24% per doubling of NT-proBNP. eGFR showed independent prognostic value from both hs-TnT and NT-proBNP. The best hs-TnT and NT-proBNP cut-offs for the prediction of all-cause death increased progressively with declining renal function (eGFR ≥ 90: hs-TnT 13 ng/L and NT-proBNP 825 ng/L; eGFR < 30: hs-TnT 40 ng/L and NT-proBNP 4608 ng/L). Patient categorization according to these cut-offs effectively stratified patient prognosis across all eGFR classes. Conclusions: hs-TnT conveys independent prognostic information from NT-proBNP, while hs-CRP does not. Concomitant assessment of eGFR may further refine risk stratification. Patient classification according to hs-TnT and NT-proBNP cut-offs specific for the eGFR classes holds prognostic significance.

Original languageEnglish (US)
Pages (from-to)166-172
Number of pages7
JournalInternational Journal of Cardiology
Volume277
DOIs
StatePublished - Feb 15 2019

Fingerprint

Troponin T
Brain Natriuretic Peptide
Glomerular Filtration Rate
Heart Failure
C-Reactive Protein
Cause of Death
Meta-Analysis
Hospitalization
Biomarkers

Keywords

  • Heart failure
  • Prognosis
  • Renal function
  • Troponin

PubMed: MeSH publication types

  • Journal Article

Cite this

High-sensitivity troponin T, NT-proBNP and glomerular filtration rate : A multimarker strategy for risk stratification in chronic heart failure. / Aimo, Alberto; Januzzi, James L.; Vergaro, Giuseppe; Ripoli, Andrea; Latini, Roberto; Masson, Serge; Magnoli, Michela; Anand, Inder; Cohn, Jay N; Tavazzi, Luigi; Tognoni, Gianni; Gravning, Jørgen; Ueland, Thor; Nymo, Ståle H.; Rocca, Hans Peter Brunner La; Bayes-Genis, Antoni; Lupón, Josep; de Boer, Rudolf A.; Yoshihisa, Akiomi; Takeishi, Yasuchika; Egstrup, Michael; Gustafsson, Ida; Gaggin, Hanna K.; Eggers, Kai M.; Huber, Kurt; Tentzeris, Ioannis; Wilson Tang, W. H.; Grodin, Justin L.; Passino, Claudio; Emdin, Michele.

In: International Journal of Cardiology, Vol. 277, 15.02.2019, p. 166-172.

Research output: Contribution to journalArticle

Aimo, A, Januzzi, JL, Vergaro, G, Ripoli, A, Latini, R, Masson, S, Magnoli, M, Anand, I, Cohn, JN, Tavazzi, L, Tognoni, G, Gravning, J, Ueland, T, Nymo, SH, Rocca, HPBL, Bayes-Genis, A, Lupón, J, de Boer, RA, Yoshihisa, A, Takeishi, Y, Egstrup, M, Gustafsson, I, Gaggin, HK, Eggers, KM, Huber, K, Tentzeris, I, Wilson Tang, WH, Grodin, JL, Passino, C & Emdin, M 2019, 'High-sensitivity troponin T, NT-proBNP and glomerular filtration rate: A multimarker strategy for risk stratification in chronic heart failure', International Journal of Cardiology, vol. 277, pp. 166-172. https://doi.org/10.1016/j.ijcard.2018.10.079
Aimo, Alberto ; Januzzi, James L. ; Vergaro, Giuseppe ; Ripoli, Andrea ; Latini, Roberto ; Masson, Serge ; Magnoli, Michela ; Anand, Inder ; Cohn, Jay N ; Tavazzi, Luigi ; Tognoni, Gianni ; Gravning, Jørgen ; Ueland, Thor ; Nymo, Ståle H. ; Rocca, Hans Peter Brunner La ; Bayes-Genis, Antoni ; Lupón, Josep ; de Boer, Rudolf A. ; Yoshihisa, Akiomi ; Takeishi, Yasuchika ; Egstrup, Michael ; Gustafsson, Ida ; Gaggin, Hanna K. ; Eggers, Kai M. ; Huber, Kurt ; Tentzeris, Ioannis ; Wilson Tang, W. H. ; Grodin, Justin L. ; Passino, Claudio ; Emdin, Michele. / High-sensitivity troponin T, NT-proBNP and glomerular filtration rate : A multimarker strategy for risk stratification in chronic heart failure. In: International Journal of Cardiology. 2019 ; Vol. 277. pp. 166-172.
@article{5f952a0bedec475eb56c5e15363b33c7,
title = "High-sensitivity troponin T, NT-proBNP and glomerular filtration rate: A multimarker strategy for risk stratification in chronic heart failure",
abstract = "Background: In a recent individual patient data meta-analysis, high-sensitivity troponin T (hs-TnT) emerged as robust predictor of prognosis in stable chronic heart failure (HF). In the same population, we compared the relative predictive performances of hs-TnT, N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP), hs-C-reactive protein (hs-CRP), and estimated glomerular filtration rate (eGFR) for prognosis. Methods and results: 9289 patients (66 ± 12 years, 77{\%} men, 85{\%} LVEF <40{\%}, 60{\%} ischemic HF) were evaluated over a 2.4-year median follow-up. Median eGFR was 58 mL/min/1.73 m 2 (interquartile interval 46–70; n = 9220), hs-TnT 16 ng/L (8–20; n = 9289), NT-proBNP 1067 ng/L (433–2470; n = 8845), and hs-CRP 3.3 mg/L (1.4–7.8; n = 7083). In a model including all 3 biomarkers, only hs-TnT and NT-proBNP were independent predictors of all-cause and cardiovascular mortality and cardiovascular hospitalization. hs-TnT was a stronger predictor than NT-proBNP: for example, the risk for all-cause death increased by 54{\%} per doubling of hs-TnT vs. 24{\%} per doubling of NT-proBNP. eGFR showed independent prognostic value from both hs-TnT and NT-proBNP. The best hs-TnT and NT-proBNP cut-offs for the prediction of all-cause death increased progressively with declining renal function (eGFR ≥ 90: hs-TnT 13 ng/L and NT-proBNP 825 ng/L; eGFR < 30: hs-TnT 40 ng/L and NT-proBNP 4608 ng/L). Patient categorization according to these cut-offs effectively stratified patient prognosis across all eGFR classes. Conclusions: hs-TnT conveys independent prognostic information from NT-proBNP, while hs-CRP does not. Concomitant assessment of eGFR may further refine risk stratification. Patient classification according to hs-TnT and NT-proBNP cut-offs specific for the eGFR classes holds prognostic significance.",
keywords = "Heart failure, Prognosis, Renal function, Troponin",
author = "Alberto Aimo and Januzzi, {James L.} and Giuseppe Vergaro and Andrea Ripoli and Roberto Latini and Serge Masson and Michela Magnoli and Inder Anand and Cohn, {Jay N} and Luigi Tavazzi and Gianni Tognoni and J{\o}rgen Gravning and Thor Ueland and Nymo, {St{\aa}le H.} and Rocca, {Hans Peter Brunner La} and Antoni Bayes-Genis and Josep Lup{\'o}n and {de Boer}, {Rudolf A.} and Akiomi Yoshihisa and Yasuchika Takeishi and Michael Egstrup and Ida Gustafsson and Gaggin, {Hanna K.} and Eggers, {Kai M.} and Kurt Huber and Ioannis Tentzeris and {Wilson Tang}, {W. H.} and Grodin, {Justin L.} and Claudio Passino and Michele Emdin",
year = "2019",
month = "2",
day = "15",
doi = "10.1016/j.ijcard.2018.10.079",
language = "English (US)",
volume = "277",
pages = "166--172",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - High-sensitivity troponin T, NT-proBNP and glomerular filtration rate

T2 - A multimarker strategy for risk stratification in chronic heart failure

AU - Aimo, Alberto

AU - Januzzi, James L.

AU - Vergaro, Giuseppe

AU - Ripoli, Andrea

AU - Latini, Roberto

AU - Masson, Serge

AU - Magnoli, Michela

AU - Anand, Inder

AU - Cohn, Jay N

AU - Tavazzi, Luigi

AU - Tognoni, Gianni

AU - Gravning, Jørgen

AU - Ueland, Thor

AU - Nymo, Ståle H.

AU - Rocca, Hans Peter Brunner La

AU - Bayes-Genis, Antoni

AU - Lupón, Josep

AU - de Boer, Rudolf A.

AU - Yoshihisa, Akiomi

AU - Takeishi, Yasuchika

AU - Egstrup, Michael

AU - Gustafsson, Ida

AU - Gaggin, Hanna K.

AU - Eggers, Kai M.

AU - Huber, Kurt

AU - Tentzeris, Ioannis

AU - Wilson Tang, W. H.

AU - Grodin, Justin L.

AU - Passino, Claudio

AU - Emdin, Michele

PY - 2019/2/15

Y1 - 2019/2/15

N2 - Background: In a recent individual patient data meta-analysis, high-sensitivity troponin T (hs-TnT) emerged as robust predictor of prognosis in stable chronic heart failure (HF). In the same population, we compared the relative predictive performances of hs-TnT, N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP), hs-C-reactive protein (hs-CRP), and estimated glomerular filtration rate (eGFR) for prognosis. Methods and results: 9289 patients (66 ± 12 years, 77% men, 85% LVEF <40%, 60% ischemic HF) were evaluated over a 2.4-year median follow-up. Median eGFR was 58 mL/min/1.73 m 2 (interquartile interval 46–70; n = 9220), hs-TnT 16 ng/L (8–20; n = 9289), NT-proBNP 1067 ng/L (433–2470; n = 8845), and hs-CRP 3.3 mg/L (1.4–7.8; n = 7083). In a model including all 3 biomarkers, only hs-TnT and NT-proBNP were independent predictors of all-cause and cardiovascular mortality and cardiovascular hospitalization. hs-TnT was a stronger predictor than NT-proBNP: for example, the risk for all-cause death increased by 54% per doubling of hs-TnT vs. 24% per doubling of NT-proBNP. eGFR showed independent prognostic value from both hs-TnT and NT-proBNP. The best hs-TnT and NT-proBNP cut-offs for the prediction of all-cause death increased progressively with declining renal function (eGFR ≥ 90: hs-TnT 13 ng/L and NT-proBNP 825 ng/L; eGFR < 30: hs-TnT 40 ng/L and NT-proBNP 4608 ng/L). Patient categorization according to these cut-offs effectively stratified patient prognosis across all eGFR classes. Conclusions: hs-TnT conveys independent prognostic information from NT-proBNP, while hs-CRP does not. Concomitant assessment of eGFR may further refine risk stratification. Patient classification according to hs-TnT and NT-proBNP cut-offs specific for the eGFR classes holds prognostic significance.

AB - Background: In a recent individual patient data meta-analysis, high-sensitivity troponin T (hs-TnT) emerged as robust predictor of prognosis in stable chronic heart failure (HF). In the same population, we compared the relative predictive performances of hs-TnT, N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP), hs-C-reactive protein (hs-CRP), and estimated glomerular filtration rate (eGFR) for prognosis. Methods and results: 9289 patients (66 ± 12 years, 77% men, 85% LVEF <40%, 60% ischemic HF) were evaluated over a 2.4-year median follow-up. Median eGFR was 58 mL/min/1.73 m 2 (interquartile interval 46–70; n = 9220), hs-TnT 16 ng/L (8–20; n = 9289), NT-proBNP 1067 ng/L (433–2470; n = 8845), and hs-CRP 3.3 mg/L (1.4–7.8; n = 7083). In a model including all 3 biomarkers, only hs-TnT and NT-proBNP were independent predictors of all-cause and cardiovascular mortality and cardiovascular hospitalization. hs-TnT was a stronger predictor than NT-proBNP: for example, the risk for all-cause death increased by 54% per doubling of hs-TnT vs. 24% per doubling of NT-proBNP. eGFR showed independent prognostic value from both hs-TnT and NT-proBNP. The best hs-TnT and NT-proBNP cut-offs for the prediction of all-cause death increased progressively with declining renal function (eGFR ≥ 90: hs-TnT 13 ng/L and NT-proBNP 825 ng/L; eGFR < 30: hs-TnT 40 ng/L and NT-proBNP 4608 ng/L). Patient categorization according to these cut-offs effectively stratified patient prognosis across all eGFR classes. Conclusions: hs-TnT conveys independent prognostic information from NT-proBNP, while hs-CRP does not. Concomitant assessment of eGFR may further refine risk stratification. Patient classification according to hs-TnT and NT-proBNP cut-offs specific for the eGFR classes holds prognostic significance.

KW - Heart failure

KW - Prognosis

KW - Renal function

KW - Troponin

UR - http://www.scopus.com/inward/record.url?scp=85056226093&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056226093&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2018.10.079

DO - 10.1016/j.ijcard.2018.10.079

M3 - Article

VL - 277

SP - 166

EP - 172

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -